INCOMPLETE CLOSURE OF THE OLECRANON APOPHYSIS

Incomplete Closure of the Olecranon Apophysis

Incomplete closure of the olecranon apophysis is a condition that occurs at the junction of the humerus and ulna, called the olecranon, at the back of the elbow. It primarily affects growing children and adolescents. The olecranon has a growth plate (apophysis), which ossifies as the bone grows. However, excessive stress can damage the growth plate, preventing it from closing (ossifying) properly.

Mechanism of Occurrence

The olecranon is the attachment site for the triceps brachii, which plays a crucial role in elbow extension. Repetitive elbow extension movements, such as baseball pitching, tennis, and gymnastics, can exert excessive traction and pressure on the olecranon growth plate, making it prone to damage. If this damage does not heal properly, ossification of the growth plate is hindered, leading to incomplete closure.

Main Causes

1. Repetitive Stress:
   ・Excessive use of the elbow in activities such as baseball pitching, gymnastics, and weightlifting.
2. Sudden Increase in Load:
   ・Significant increase in the number of pitches or practice sessions within a short period.
3. Improper Form:
   ・Movements that place excessive stress on the arm due to poor form.
4. Structural Weakness During Growth:
   ・The immature growth plate is more susceptible to external forces.

Symptoms

1. Pain at the Back of the Elbow:
   ・Pain occurs after sports activities initially, but may persist at rest as the condition progresses.
2. Swelling and Tenderness:
   ・Mild swelling around the olecranon, with pain upon touching the area.
3. Movement Restriction:
   ・Difficulty fully extending or bending the elbow.
4. Muscle Weakness:
   ・Weakness in extending the elbow due to pain.
5. Chronic Discomfort:
   ・Persistent symptoms may cause discomfort in elbow movements.

Diagnosis

1. Medical History and Physical Examination:
   ・Check the location and onset of pain, and sports history.
   ・Evaluate tenderness, swelling, and range of motion of the elbow.
2. Imaging Tests:
   ・X-ray:Confirm enlargement, irregularity, or delayed closure of the growth plate.
   ・MRI:Detailed evaluation of soft tissue and bone damage.
   ・CT Scan:Used to confirm detailed structure of the growth plate.

Treatment

Conservative Therapy (Mild to Moderate)

1. Cessation of Sports Activities:
   ・Temporarily stop sports to avoid further stress.
2. Icing:
   ・Cool the area to reduce pain and swelling.
3. Use of Orthotics:
   ・Stabilize the elbow with elbow supports or splints.
4. Rehabilitation:
   ・Exercise therapy to restore strength and maintain flexibility of the elbow.
5. Periodic Monitoring:
   ・Regular imaging tests to monitor the recovery of the growth plate.

Surgical Therapy (Severe or Advanced Cases)

• Repair of the Growth Plate:
  ・Fixation or realignment surgery if the damage to the growth plate is severe.
• Bone Grafting:
  ・Applied in cases of bone deficiency due to advanced incomplete closure of the growth plate.

Recovery Period

• Mild: Recovery in a few weeks to a few months.
• Moderate: Requires several months of rehabilitation.
• Severe: May take over six months for complete recovery post-surgery.

Prevention

1. Proper Form Guidance:
   ・Learn techniques to reduce stress on the elbow during pitching or exercising.
2. Strict Adherence to Pitching Limits:
   ・Follow pitch counts and ensure rest days.
3. Strength Training:
   ・Strengthen not only the elbow but also the shoulder and core muscles.
4. Improvement of Flexibility:
   ・Perform thorough stretching and warm-up before and after practice.
5. Early Intervention:
   ・Consult a specialist promptly if there is pain or discomfort in the early stages.

Note: If symptoms are left untreated, it can lead to elbow deformities and functional impairments. Proper stress management and early diagnosis are particularly important for children during their growth phase.

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